放疗后复发食管癌三维适形放疗的临床分析

Three-dimensional conformal radiotherapy for recurrent esophageal cancer after initial radical radiotherapy

目的 探讨三维适形放疗（3DCRT）治疗首程放疗后局部复发食管癌患者的疗效、放射损伤和影响预后的因素.方法 2011 年10 月至2014 年10 月对34 例首程放疗后局部复发的食管癌患者实施3DCRT 二程放疗,放疗剂量30.4～66.0 Gy,中位剂量55.0 Gy,1.8～2.0 Gy/次,5 次/周.结果 随访截至2014 年12 月,随访率100%.34 例中临床症状缓解率91.2%,病灶完全缓解率29.4%（10/34）、部分缓解率52.9%（18/34）、无进展率17.6%（6/34）.全组患者1、2 年总生存率分别为35.3%、8.8%.全组≥2 级放射性食管炎29 例,其中2 级26 例,3 级3 例.2 级放射性肺炎11 例.结论 3DCRT 可作为放疗后复发食管癌的有效治疗手段,但二程放疗并发症较高,临床应用时应严格掌握其适应证.

Objective To evaluate the therapeutic effects, normal tissue complications and prognosis of three-dimensional conformal radiotherapy (3DCRT) for recurrent esophageal cancer after initial radicalradiotherapy.MethodsBetween October 2011 and October 2014, 34 patients with recurrent esophageal cancer after initial radicalradiotherapy were treated with 3DCRT. Radiotherapy was delivered at 1.8-2.0 Gy per fraction, 5 fractions per week, with a median total dose of 55.0 Gy (30.4-66.0 Gy). Treatment outcomes and normal tissue complications were assessed with WHO and RTOG/EORTC criteria. ResultsBy December 2014, the follow-up rate was 100%. The clinical symptom relief rate was 91.2%, and the response rate was 82.4% with a complete remission rate of 29.4% (10/34) and partial remission rate of 52.9% (18/34). The overall 1- and 2-year survival rates were 35.3% and 8.8%. Grade 2 and grade 3 acute radiation esophagitis developed in 76.5% (26/34) and 8.8% (3/34) of the patients, respectively. Grade 2 acute radiation pneumonitis developed in 32.4% (11/34).ConclusionFor the patients with recurrent esophageal cancer after initial radicalradiotherapy, 3DCRT is feasible, with a good clinical symptom relief rate and immediate tumor response. However, the complication rate was high and the clinical indications should be strictly controlled.